Forging a path for gender equality in medicine

I read with cautious optimism the Diversity Pledge and No–All Male Panel Policy recently announced by the Lancet Group.1 This initiative comes at a crucial time, on the heels of a renewed interest and attention to gender inequities in medicine.

Dr. Iberia Romina Sosa

Despite 50-year-old federal legislation mandating that men and women receive equal compensation for equal work, pay inequities persist in all aspects of the workforce and medicine is no exception. In 2018, the American College of Physicians published a position paper acknowledging that, despite an increase in women in the active physician workforce and training positions, our numbers remain disproportionately low in leadership positions, with a mediocre track record for career advancement.2 Inadequate mentorship, discrimination, gender bias, imposter syndrome and a lack of work-life integration have all been cited as contributing to the problem.

Consensus and commitment statements are important first steps in legitimizing a problem, but they do not always engender change. They run the risk of creating an “illusion of fairness” that lulls us into a sense of complacency that change is coming and yet it never does. This is why the Lancet Group’s pledge is so remarkable in its scope. Less than a year after the timely ACP position paper, the Lancet Group published a theme issue addressing the systematic concerns surrounding gender bias in medicine.

Recognizing that publications are prime currency in medicine, the Lancet Group has declared its commitment to increase the representation of women, minorities, and underrepresented geographic areas in editorial boards, peer review, and authorship. Since their #LancetWomen issue, 8 of their 18 journals have refreshed their editorial boards to include at least 50% female membership, with a goal of all 18 journals achieving this landmark by year’s end. That this change is being catapulted by a major publishing group suggests that a necessary cultural transformation is underway.

Today, women are entering the medical field in equal numbers to men. While some may argue that we have achieved gender diversity in medicine, we must not confuse this with gender equity, which remains a distant goal. This is a ripe time in medicine. We have momentum and an opportunity for change.

In an editorial comment to the ACP position paper, Molly Carnes, MD, drew an analogy to the Surgeon General’s report in 1964, which announced that smoking was detrimental to health. The report legitimized the already overwhelming evidence that smoking negatively impacted clinical outcomes and it served as a trigger to propel change.3 Similarly, we hope the ACP position has legitimized the research highlighting gender disparities in medicine and that the Lancet Group’s initiative is among the first of many changes to come.

This change must be embraced and executed by leadership across medical schools, universities, and professional societies. We must collectively pursue interventions and solutions to the multifaceted problem of gender inequity. After all, women have become an integral part of the medical workforce and we all need to work together to ensure both genders have sustainable careers.

Dr. Sosa is a benign hematologist at Fox Chase Cancer Center in Philadelphia. Her research interests are in thromboembolic disease, with a focus in racial and gender disparities.